A physician assistant (US) or physician associate (UK) is a healthcare professional who practices medicine as a part of a healthcare team with collaborating physicians and other providers. In the United States, PAs are nationally certified and state licensed to practice medicine. A certified PA may use "C" at the end of his/her credentials. PAs are trained using the medical model and complete these qualifications in less time than a traditional medical degree. The PA education model is based on the fast-track training of doctors during World War II.

PAs are concerned with preventing and treating human illness and injury by providing a broad range of health care services with a collaborating physician.[1] Their scope of practice can vary according to jurisdiction and healthcare setting. Accordingly, their work may include conducting physical exams, ordering and interpreting tests, diagnosing illnesses, developing treatment plans, care coordination, performing procedures, prescribing medications, clinical research, advising on preventive health care, and doing first assist in surgery.[2]

The occupational title originated in the United States in the 1960s; similar occupations outside the US include clinical officers in parts of Africa and feldshers in countries of the former Soviet Union.[3]

Physician assistants or physician associates (PAs) may undertake tasks such as: obtain medical histories, perform examinations and procedures, order treatments, diagnose diseases, prescribe medication, order and interpret diagnostic tests, care coordination, clinical research, refer patients to specialists as needed, and first assist in surgery. They train to work in settings such as hospitals, clinics and other types of health facilities, or in academic administration, and exercise autonomy in medical decision making. PAs practice primary care or medical specialties, including emergency medicine, surgery, cardiology, etc. according to a legal scope of practice that may vary across jurisdictions. A period of extensive clinical training precedes obtaining a license to practice as a physician assistant, and similar to physician training but shorter in duration, includes all systems of the human body. Renewal of licensure is necessary every few years, varying by jurisdiction. PAs may also complete residency training, similar to physicians' residencies but significantly shorter, in fields such as: OB/GYN, emergency medicine, critical care, orthopaedics, neurology, surgery, and other medical disciplines.

PAs are currently practicing across Canada in the Canadian Armed Forces and are working in the public health care system in the provinces of Manitoba, Ontario, New Brunswick and Alberta. PAs are regulated in Manitoba and New Brunswick by the respective provincial college of physicians and surgeons. In both Ontario and Alberta, the profession is not regulated. However, the Ontario Minister of Health has recommended that a mandatory registry be established which would be governed by the College of Physicians and Surgeons of Ontario. In Alberta, a voluntary registry has been established for PAs under the College of Physicians and Surgeons of Alberta. PAs are permitted to practice, by way of delegation, under the provincial Medical Act. PAs are represented by the Canadian Association of Physician Assistants, which had formed in October 1999 as the "Canadian Academy of Physician Assistants".[14]

The position of physician associate (PA) has been established in the United Kingdom since 2005. The position evolved from the position of physician assistant, developed in the USA in the 1960s. In 2012, the profession voted to change the name of physician associate to distinguish the position from another one with the same name within the NHS.

Faculty of Physician Associates at the Royal College of Physicians of London[edit]

The Faculty of Physician Associates (FPA) is the professional body for Physician Associates working in the United Kingdom. A joint venture between the Royal College of Physicians of London and the previous professional body, the United Kingdom Associate of Physician Associates (UKAPA), the Faculty officially launched in July 2015, taking over all professional body rights from then on. The Faculty oversee the managed voluntary register, to which all practising PAs are encouraged to become a member of, as well as setting and running the National Assessment Examination and National Recertification Examination.

PAs are trained under the medical model, similarly to doctors, to deliver high-quality medical care in both primary and secondary care settings. The role of PAs has developed to provide medical services similar to those provided by house officers or senior house officers. They are trained to perform a variety of tasks including diagnosis and taking medical histories.[16]

They work under the direct supervision of a doctor. Due to the infancy of the profession, there is currently limited progression to senior posts, but there has been an emphasis on employers to develop dedicated study leave and training times to help develop their skills, this is often paired with junior doctor training. The current avenues which PAs can develop their skills are through research, teaching, training to become first assistants in surgery and running outpatient clinics and post-surgical follow ups. Tasks they perform include medical history taking, interpreting ECG and venipuncture/blood draws, among others.[17]

The title of physician associate is not a protected medical profession. Hence, even if a PA has been trained in pharmacology and IRMER[18] (ability to request radiology imaging – X-rays), they are not able to prescribe or request imaging.[19] At present, there is no regulatory body for PAs, such as the General Medical Council (GMC) for doctors. Since June 2010, physician associates have been able to obtain membership of the Managed Voluntary Register (MVR) for Physician Associates.[20] This database, run by PAs for PAs, aims to identify all qualified PAs who are able to practise in the United Kingdom. It is intended to maintain high standards in the UK.[21] To remain on the register, Physician associates in the United Kingdom are required to re-certify every 5–6 years[22] and maintain up-to-date practice through attendance of training accumulating CPD hours (Continuous professional development), which need to be completed on an annual basis.

Aberdeen requires a science-based degree with a minimum 2:1 grade achieved and St George's requires a science-based degree with a minimum 2:2 grade achieved. This includes Sport Science, Biology, Geology, Psychology and Biomedical degrees. Applicants should preferably have experience in the healthcare industry, such as a HCA or auxiliary nursing. Applications from other professionals such as nurses, radiographers and paramedics will also be considered.

University of Bradford requires a 2:1 (or above) undergraduate degree in a Life Science, Biomedical Science, or Healthcare subject. Under exceptional circumstances, extensive experience in healthcare practice may contribute and compensate if the above requirements have not been fully met.[24]

In the United States, the profession is represented by the American Academy of Physician Assistants, and all PAs must graduate from a nationally accredited ARC-PA program as well as passing the national certification exam.[34] It was not until 1970 that the AMA passed a resolution to develop educational guidelines and certification procedures for PAs.[4] The Duke University Medical Center Archives had established the Physician Assistant History Center, dedicated to the study, preservation, and presentation of the history of the PA profession. The PA History Center became its own institution in 2011, was renamed the PA History Society, and is now located in Johns Creek, Georgia.[35]

As of October 2016[update], there were 218 accredited PA programs in the United States, and dozens more in development, represented by the Physician Assistant Education Association (PAEA).[36] Most educational programs are graduate programs leading to the award of master's degrees in either Physician Assistant Studies (MPAS), Health Science (MHS), or Medical Science (MMSc), and require a bachelor's degree and GRE or MCAT scores for entry. The majority of PA programs in the United States utilize the CASPA application for selecting students.[36] Professional licensure is regulated by the medical boards of the individual states. Physician Assistant students train at medical schools and academic medical centers across the country.

Physician assistant education is based on medical education[37] although unlike medical school which lasts four years plus a specialty-specific residency, PA training is usually 2 to 3 years of full-time study, completed during their post-graduate studies, for a total of 6–7 years of science-based postsecondary education.[38] The didactic training of PA education consists of classroom and laboratory instruction in medical and behavioral sciences, such as anatomy, microbiology, immunology, pharmacology, pathophysiology, hematology, pathology, genetics, clinical medicine, and physical diagnosis, followed by clinical rotations in internal medicine, family medicine, surgery, pediatrics, obstetrics and gynecology, emergency medicine, and geriatric medicine, as well as elective rotations.[citation needed] Unlike physicians, who must complete a minimum of three years of residency after completion of medical school, PAs are not required to complete such residencies after they complete their schooling. Despite this, there are residency programs in certain specialties for PAs who choose to continue formal education in such a format.[39]

PA clinical postgraduate programs are clinical training programs which differ from training on the job in their inclusion of didactic education and supervised clinical experience to meet learning objectives which are clearly defined.[40] The Montefiore Medical Center Postgraduate Surgical Physician Assistant Program was established in 1971 as the first clinical postgraduate PA program to be recognized.[40] Currently, there are known to be 49 programs in various specialties such as Neurology, Trauma/Critical Care and Oncology.[41] The Association of Postgraduate Physician Assistant Programs was formed in 1988 as an instrument in the establishment of educational standards for postgraduate PA programs[40] and currently includes 50 member programs.[41]

A physician assistant may use the post-nominal initials "PA", "PA-C", "APA-C", "RPA" or "RPA-C", where the "-C" indicates "Certified" and the "R" indicates "Registered". The "R" designation is unique to a few states, mainly in the Northeast. APA stands for aeromedical physician assistant and indicates that a physician assistant successfully completed the U.S. Army Flight Surgeon Primary Course.[42] During training, PA students are designated PA-S. The use of "PA-C" is limited only to those PAs currently certified and in compliance with the regulations of the national certifying organization, the National Commission on Certification of Physician Assistants and who have passed the PANCE.

In the United States, a graduate from an accredited PA program must pass the NCCPA-administered Physician Assistant National Certifying Exam (PANCE) before becoming a PA-C; this certification is required for licensure in all states.[43] The content of the exam is covered in the PANCE BLUEPRINT. In addition, a PA must log 100 Continuing Medical Education (CME) hours and reregister his or her certificate with the NCCPA every two years. Every ten years (formerly six years), a PA must also recertify by successfully completing the Physician Assistant National Recertifying Exam (PANRE)[44][45]

"National Physician Assistant Week" is celebrated annually in the US from October 6 through October 12. This week was chosen to commemorate the anniversary of the first graduating physician assistant class at Duke University on October 6, 1967.[46]

Physician assistants have their own licenses with distinct scope of practice.[47] Each of the 50 states has different laws regarding the prescription of medications by mid-level practitioners (which include PAs) and the licensing authority granted to each category within that particular State through the Drug Enforcement Administration (DEA).[48] PAs in Kentucky, Puerto Rico and the U.S. Virgin Islands are not allowed to prescribe any controlled substances.[49] Several other states place a limit on the type of controlled substance or the quantity that can be prescribed, dispensed, or administered by a PA.[49]

Depending upon the specific laws of any given state board of medicine, the PA must have a formal relationship on file with a collaborative physician supervisor. The physician supervisor must also be licensed in the state in which the PA is working, although he or she may physically be located elsewhere. Physician supervision can be in person, by telecommunication systems or by other reliable means (for example, availability for consultation).

The U.S. Department of Labor Bureau of Labor Statistics report on PAs states, "...Employment of physician assistants is expected to grow 27 percent from 2006 to 2016, much faster than the average for all occupations..."[55] This is due to several factors, including an expanding health care industry, an aging baby-boomer population, concerns for cost containment, and newly implemented restrictions to shorten physician resident work hours.

For PAs in primary care practice, malpractice insurance policies with $100,000–300,000 in coverage can cost less than $600 per year; premiums are higher for PAs in higher-risk specialties.[56]

Money magazine, in conjunction with Salary.com, listed the PA profession as the "fifth best job in America" in May 2006, based both on salary and job prospects, and on an anticipated 10-year job growth of 49.65%.[57] In 2010, CNN Money rated the Physician Assistant Career as the number two Best Job In America.[58] In 2012, Forbes rated the Physician Assistant Degree as the number one master's degree for jobs.[59] In 2015, Glassdoor rated Physician Assistant as the Number One Best Job In America.[60] According to the 2014 National Salary Survey of PAs, the mean total income for physician assistants working full-time was $112,344.[61] Physician assistants in emergency medicine, dermatology, and surgical subspecialties may earn $100,000 to $200,000 per year.[62]

PAs are employed by the United States Department of State as Foreign Service Health Practitioners (FSHP). PAs working in this capacity may be deployed anywhere in the world where there is a State Department facility. They provide primary care to U.S. government employees and their families in American embassies and consulates around the world. An important part of their jobs is to get to know what resources are available locally that they can count on in an emergency. FSHPs have some other important roles, such as advising their ambassadors on the health situation in the country and provide health education to the diplomatic community. In order to be considered for the position of FSHP these PAs must be licensed and have at least two years of recent experience in primary care.[63]

Military PAs serve in the White House Medical Unit, where they provide care to the president and vice president and their families as well as White House staff.

The Marine Physician Assistant (MPA) is a U.S. Merchant Mariner Staff Officer. A Certificate of Registry is granted through The United States Coast Guard National Maritime Center (NMC) located in Martinsburg, West Virginia.[65] Formal training programs for Marine Physician Assistants began in September, 1966 at the Public Service Health Hospital located in Staten Island, N.Y.[66]

^which also was the first employer of PAs. Mr. Vic Germino one of the first three graduates was employed by the VA and he remained with the VA for over 25 years.l 2008 AAPA Physician Assistant Census Report. Table 3.4: Number and Percent Distribution of Clinically Practicing Respondents by Primary Work Setting